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NAPLEX review 2024 RXPrep Book > Oncology: Oncology I: Overview & Side Effect Management > Flashcards

Oncology: Oncology I: Overview & Side Effect Management Flashcards

1
Q

Neoadjuvant therapy is given…

A

before primary treatment to shrink size

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2
Q

Adjuvant therapy is given…

A

after primary therapy or with other therapy to get rid of remaining disease and decrease recurrence

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3
Q

Warning signs of cancer

A

C = change in bowel/bladder habits
A = sore that doesnt heal
U = unusual bleeding or discharge
T = thickening or lump in breast or elsewhere
I = indigestion or difficulty swallowing
O = obvious change in wart or mole
N = nagging cough or hoarseness

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4
Q

Breast cancer screening

A

40-44 = annual mammogram optional
45-54 = yearly mammogram
55 + = mammograms Q 2 yrs or yearly

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5
Q

Cervical cancer screening

A

25-65 yrs old

Pap smear every 3 yrs
HPA DNA test every 5 years
Pap smear + HPV test every 5 yrs

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6
Q

Colorectal stool based screening

A

> 45 yrs old
if positive, get a colonoscopy

FIT test yearly
gFOBT yearly
stool DNA test every 3 years

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7
Q

Colorectal visual based screening

A

> 45 yrs old

Colonoscopy every 10 yrs
CT colonography every 5 years
Flexible sigmoidoscopy every 5 yrs

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8
Q

Lung cancer screening

A

> 50 yrs old

annual CT of chest if….

  1. 20 pack/yr smoking history
  2. still smoking or quit last 15 yrs
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9
Q

Prostate cancer screening

A

if choose to get tested…

PSA
Digital rectal exam

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10
Q

Lifetime cumulative dose of Bleomycin

A

400 units
Pulmonary toxicity

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11
Q

Lifetime cumulative dose of Doxorubicin

A

450-550mg/m2
cardio toxicity

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12
Q

Lifetime cumulative dose of Cisplatin

A

no more than 100mg/m2 per cycle
Nephrotoxicity

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13
Q

Lifetime cumulative dose of Vincristine

A

single dose capped at 2mg
Neuropathy

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14
Q

Common drugs that cause Myelosuppression

A

Most chemo agents besides…..

  1. asparaginase
  2. bleomycin
  3. vincristine
  4. most monoclonal antibodies
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15
Q

Common drugs that cause nausea and vomiting

A

Cisplatin
cyclophosphamide
ifosfamide
doxorubicin
epirubicin

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16
Q

Common drugs that cause mucositis

A

fluorouracil
methotrexate
capecitabine
irinotecan
many TKIs

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17
Q

Common drugs that cause diarrhea

A

Irinotecan
capecitabine
fluorouracil
methotrexate
many TKIs

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18
Q

Common drugs that cause Constipation

A

Vincristine
pomalidomide
thalidomide

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19
Q

Common drugs that cause Xerostomia (dry mouth)

A

radiation to head or neck regions

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20
Q

Common medications that cause Cardiomyopathy

A

Anthracyclines
HER2 inhibitors
fluorouracil

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21
Q

Common medications that cause QT prolongation

A

Arsenic trioxide
many TKIs
Leuprolide

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22
Q

Common medications that cause Pulmonary fibrosis

A

Bleomycin
busulfan
carmustine
lomustine

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23
Q

Common medications that cause Pneumonitis

A

Methotrexate
MAbs targeting CTLA-4 or PD-1/PD-L1

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24
Q

Common medications that cause hepatotoxicity

A

Antiandrogens (bicalutamide, flutamide, nilutamide)
methotrexate
cytrabien
Many TKIs
some MAbs

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25
Q

Common medications that cause Nephrotoxicity

A

Cisplatin
High dose Methotrexate

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26
Q

Common medications that cause Hemorrhagic Cystitis

A

Ifosfamide = all doses
cyclophosphamide = high dose > 1g/m2

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27
Q

Common medications that cause Peripheral Neuropathy

A

Vinca alkaloids
Platinums
Taxanes
Proteasome inhibitors

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28
Q

Common medications that cause Autonomic Neuropathy

A

Vinca Alkaloids

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29
Q

Common medications that cause Thromboembolic risk

A

Aromatase inhibitors (anastrozole, letrozole)
SERMs
immunomodulators (thalidomide, lenalidomide, pomalidomide)

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30
Q

What should be avoided with Oxaliplatin

A

avoid cold temperatures and avoid drinking cold beverages

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31
Q

What is myelosuppression

A

dec in bone marrow activity
results in fever RBCs, WBCs, and platelets
complication of most chemo therapy

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32
Q

Lowest point that WBCs and platelets can reach is called…

A

nadir
usually within 7-14 days after chemo

for RBC, nadir is ~ 120 days

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33
Q

Drugs used to inc RBC count

A

ESA = Erythropoiesis-stimulating agent

Epoetin alfa (Epogen, Procrit)
Darbepoetin alfa (Aranesp)

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34
Q

Drugs used to inc WBC count

A

Colony-stimulating factor (CSF)

Filgrastim (Neupogen)
Pegfilgrastim (Neulasta)

35
Q

Categories of Neutropenia and ANC

A

Neutropenia = < 1,000
Severe Neutropenia = < 500
Profound Neutropenia = < 100

36
Q

Who should receive CSF when getting chemo?

A

all patients with > 20% chance of developing chemotherapy induced febrile neutropenia

37
Q

CSF side effects

A

bone pain, fever, general rash, injection site reaction

38
Q

CSF notes

A

store in fridge

give 1st dose no sooner than 24hrs after chemo, can be up to 96hrs after
report signs of enlarged spleen

Pegfilgrastim: given atleast 14 days before next chemo cycle

39
Q

Febrile neutropenia diagnosis requirements

A

Temp > 38.3C (101F) X 1 or > 38C (100.4F) for 1hr & ANC < 500 or ANC < 1000 expected to be < 500 next 48hrs

40
Q

Empiric febrile neutropenia abx for low risk patients

A

Low risk = ANC < 100 for < 7 days

Cipro/Levo + Amox/clav or clinda

41
Q

Empiric febrile neutropenia abx for high risk patients

A

High risk = ANC < 100 for > 7 days, comorbidities, CrCl < 30

Cefepime or Ceftazdime or Meropenem or Impinge/cilastatin or pip/tazo

42
Q

Why are ESA not recommended in patients receiving chemo with curative intent?

A

can shorten survival and inc tumor progression
only used for palliative care in chemo

43
Q

What would be assessed before doing ESA?

A

Serum ferritin
TSAT
TIBC

44
Q

Threshold for platelet transfusion

A

<10K

< 30k if active bleeding

45
Q

3 types of Chemotherapy induced nausea and vomiting

A

Acute = within 24hrs of chemo
Delayed = > 24 hrs after chemo
Anticipatory = before chemo

46
Q

Antiemetic regimen for minimal emetic risk drugs

A

no routine prophylaxis

47
Q

Antiemetic regimen for low emetic risk drugs

A

1 of the following

5HT3-RA ( -setrons), Dexamethasone, prochloprperazine, metoclopramide

48
Q

Antiemetic regimen for moderate emetic risk drugs

A

2 - 3 drugs

5HT3-RA + NK1-RA + dexamthasone
5HT3-RA + dexamethasone
Palonosetron + Olanzapine + dexamethasone

49
Q

NK1-RA drugs

A

Aprepitant
Aprepitant IV
Fosaprepitant IV
Rolapitant

50
Q

Antiemetic regimen for high emetic risk drugs

A

3 or 4 drugs

NK1-RA + 5HT3-RA + olanzapine + dexamethasone = preferred

Palonosetron + olanzapine + dexamethasone

NK1-RA + 5HT3-RA + dexamethasone

51
Q

NK1-RA drug notes

A

can dec dexamethasone dose when used with these drugs

dont dec dexamethasone dose when used with Rolapitant

52
Q

Granisetron patch notes

A

start 24-48hrs before chemo
leave in place for up to 7 days

53
Q

5HT3-RA medication contraindications

A

Dont use with apomorphine (Awoken) due to severe hypotension and loss of consiousness

54
Q

5HT3-RA medication warnings

A

inc QT interval, Torsades
limit IV to 16mg
SErotonin syndrome when used in combo with serotonergic agents

55
Q

5HT3-RA medication side effects

A

headache
constipation
fatigue
dizziness
inj site reactions

56
Q

Dexamethasone (Decadron) used for CINV

A

Off label

Side effects: inc appetite, weight gain, fluid retention, insomnia

higher doses can inc BP and BG in diabetes patients

57
Q

Dopamin receptor antagonists for CINV

A

Prochlorperazine (Compazine)
Promethazine (Phenergan)
Metoclopramide (Reglan)
Olanzapine (Zyprexa)
Haloperidol (Haldol)

58
Q

Prochlorperazine boxed warnings

A

inc mortality in elderly with dementia related psychosis

59
Q

Promethazine Boxed warnings

A

dont use children < 2 yrs old
Dont give via SC, Deep IM preferred due to extravasation with IV

60
Q

Metocloramide Boxed warnings

A

Tardive dyskinesia that can be irreversible, D/c if symptoms occur
dont treat more than 12 wks
dec dose with renal impairment

61
Q

Haldol/Droperidol Boxed warnings

A

QT prolongation and serious arrhythmia

62
Q

Dopamine receptor antagonists warnings

A

symptoms of Parkinson’s maybe exacerbated, avoid in patients with disease

63
Q

Dopamine receptor antagonist side effects

A

Sedation
lethargy
acute EPS
dec seizure threshold
QT prolongation
NMS
hypotension

64
Q

Olanzapine side effects for CINV

A

mild sedation and orthostasis when used for CINV

65
Q

Dronabinol (Marinol) info

A

SE: somnolence, euphoria, inc appetite

Keep in fridge**

66
Q

Meds used for anticipatory N/V

A

Lorazepam, start evening before

67
Q

Chemo agents that commonly cause diarrhea

A

Fluorouracil
Capecitabine
Irinotecan

occurs several days after chemo

68
Q

Early onset diarrhea

A

Irinotecan cause cause it, occurs during infusion
also causes symptoms of cholinergic excess

69
Q

Cholinergic excess symptoms

A

cramping
rhinitis
lacrimation
salivation

70
Q

Hand-foot syndrome commonly occurs with

A

capecitabine
fluorouracil
cytarabine
liposomal doxorubicin
TKIs = sorafenib and sunitinib

71
Q

symptoms of Hand-foot syndrome

A

tenderness
pain
inflammation
maybe peeling of palms and soles

72
Q

Hand-foot syndrome management

A

avoid pressure on sole and palms of hands
avoid prolonged exposure to hot water
avoid activities that cause friction or heat exposure to hands/feet

73
Q

Tumor lysis syndrome occurs most commonly with which cancers

A

Leukemia and non-Hodgkin Lymphoma
but can occur with most cancer types

74
Q

Meds used to treat TLS

A

Allopurinol at 400-800mg/day until normalization

75
Q

Tumor Lysis syndrome can cause

A

acute hyperkalemia = arrythmias
hyperphosphatemia/hypercalcemia = anorexia, nausea, seizures)
hyperuricemia

76
Q

Hypercalcemia of malignancy

A

some cancers cause calcium to leach from bone to blood, leading to hypercalcemia

77
Q

Txm of moderate to severe hypercalcemia

A

Corrected calcium form 12-13.9 to > 14

Iv bisphosphonates = 1st line
calcitonin can be added, but short txm duration due to tachyphylaxsis w/ calcitonin

Can also use Denosumab (Xgeva)

78
Q

IV Bisphosphonates + Denosumab Dose

A

Bisphosphonates = 4mg IV once, can repeat in 7 days if needed
Denosumab = 120mg SC days 1,8,15 of 1st month, then every month

79
Q

Premedication to prevent immunologic reactions from MAbs

A

Tylenol
Benadryl or another antihistamine

80
Q

Major chemo vesicants

A

Anthracyclines
vinca alkaloids

81
Q

Antidote for Anthracycline extravasation

A

dexrazoxane or dimethyl sulfoxide

82
Q

Antidote for vinyl alkaloid/etoposide extravasation

A

hyaluronidase

83
Q

When should vaccines be given if receiving chemo therapy?

A

> 2 weeks prior

NAPLEX review 2024 RXPrep Book (78 decks)

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